Although these studies are uncontrolled and mostly retrospective, the response rates indicate that TSEB is highly effective for CTCL. The lack of a long-term response in early-stage disease suggests that TSEB should be reserved for later stages of disease, particularly as an RCT has indicated that responses are similar for TSEB and topical mechlorethamine. Meta-analysis of observational data indicates that higher dosage regimens are more effective (32-40 Gy with 4-6 MeV).
Although an RCT in CTCL indicates that combined TSEB and chemotherapy is no more effective than sequential skin-directed therapy, a further trial comparing TSEB alone with TSEB and chemotherapy in late stages of disease (stage IIB) would be helpful. The current data on long-term DFS and OS in erythrodermic CTCL suggest that TSEB is effective, particularly if combined with ECP, but this requires confirmation in an RCT.
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